Dataset Information

Defining 'actionable' high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology.

ABSTRACT: BACKGROUND:A small proportion of the population consumes the majority of health care resources. High-cost health care users are a heterogeneous group. We aim to segment a provincial population into relevant homogenous sub-groups to provide actionable information on risk factors associated with high-cost health care use within sub-populations. METHODS:The Canadian Institute for Health Information (CIHI) Population Grouping methodology was used to define mutually exclusive and clinically relevant health profile sub-groups. High-cost users (>?=?90th percentile of health care spending) were defined within each sub-group. Univariate analyses explored demographic, socio-economic status, health status and health care utilization variables associated with high-cost use. Multivariable logistic regression models were constructed for the costliest health profile groups. RESULTS:From 2015 to 2017, 1,175,147 individuals were identified for study. High-cost users consumed 41% of total health care resources. Average annual health care spending for individuals not high-cost were $642; high-cost users were $16,316. The costliest health profile groups were 'long-term care', 'palliative', 'major acute', 'major chronic', 'major cancer', 'major newborn', 'major mental health' and 'moderate chronic'. Both 'major acute' and 'major cancer' health profile groups were largely explained by measures of health care utilization and multi-morbidity. In the remaining costliest health profile groups modelled, 'major chronic', 'moderate chronic', 'major newborn' and 'other mental health', a measure of socio-economic status, low neighbourhood income, was statistically significantly associated with high-cost use. INTERPRETATION:Model results point to specific, actionable information within clinically meaningful subgroups to reduce high-cost health care use. Health equity, specifically low socio-economic status, was statistically significantly associated with high-cost use in the majority of health profile sub-groups. Population segmentation methods, and more specifically, the CIHI Population Grouping Methodology, provide specificity to high-cost health care use; informing interventions aimed at reducing health care costs and improving population health.

SUBMITTER: Anderson M

PROVIDER: S-EPMC6842471 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Defining 'actionable' high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology.

Anderson Maureen M Revie Crawford W CW Stryhn Henrik H Neudorf Cordell C Rosehart Yvonne Y Li Wenbin W Osman Meriç M Buckeridge David L DL Rosella Laura C LC Wodchis Walter P WP

International journal for equity in health 20191110 1

<h4>Background</h4>A small proportion of the population consumes the majority of health care resources. High-cost health care users are a heterogeneous group. We aim to segment a provincial population into relevant homogenous sub-groups to provide actionable information on risk factors associated with high-cost health care use within sub-populations.<h4>Methods</h4>The Canadian Institute for Health Information (CIHI) Population Grouping methodology was used to define mutually exclusive and clini ...[more]

PMID: 31707981

Similar Datasets

Project description:BackgroundPragmatic trials evaluating complex health interventions often compare them to usual care. This comparator should resemble care as provided in everyday practice. However, usual care can differ for the same condition, between patients and practitioners, across clinical sites and over time. Heterogeneity within a usual care arm can raise methodological and ethical issues. To address these it may be necessary to standardise what usual care entails, although doing so may compromise a trial's external validity. Currently, there is no guidance detailing how researchers should decide the content of their usual care comparators. We conducted a methodology review to summarise current thinking about what should inform this decision.MethodsMEDLINE, Embase, CINAHL and PsycINFO were searched from inception to January 2022. Articles and book chapters that discussed how to identify or develop usual care comparators were included. Experts in the field were also contacted. Reference lists and forward citation searches of included articles were screened. Data were analysed using a narrative synthesis approach.ResultsOne thousand nine hundred thirty records were identified, 1611 titles and abstracts screened, 112 full texts screened, and 16 articles included in the review. Results indicated that the content of a usual care comparator should be informed by the aims of the trial, existing care practices, clinical guidelines, and characteristics of the target population. Its content should also be driven by the trial's requirements to protect participants, inform practice, and be methodologically robust, efficient, feasible and acceptable to stakeholders. When deciding the content of usual care, researchers will need to gather information about these drivers, balance tensions that might occur when responding to different trial objectives, and decide how usual care will be described and monitored in the trial.DiscussionWhen deciding the content of a usual care arm, researchers need to understand the context in which a trial will be implemented and what the trial needs to achieve to address its aim and remain ethical. This is a complex decision-making process and trade-offs might need to be made. It also requires research and engagement with stakeholders, and therefore time and funding during the trial's design phase.Trial registrationPROSPERO CRD42022307324.

Project description:IntroductionPhysical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use.MethodsWe conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.ResultsPR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre-existing psychiatric condition or dementia) were not associated with PR use or number of days used.ConclusionsPR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.

Project description:BackgroundAccurate estimates of the usual intake of nutrients are important for monitoring nutritional adequacy and diet quality of populations. In Canada, comprehensive, nationally representative nutrient estimates have not been available since the Canadian Community Health Survey (CCHS)-Nutrition 2004 survey.ObjectiveThe objective of this research was to assess nutrient intakes, distributions, and adequacy of the intakes of Canadian adults.MethodsParticipants' first 24-h dietary recall, and the second-day recall from a subset of participants from the recently released CCHS 2015 Public Use Microdata File (PUMF) were used to estimate usual intakes of macronutrients, vitamins, and minerals in adults [≥19 y, excluding lactating females and those with invalid energy intake (EI)]. Usual intakes by DRI age-sex groups were estimated using the National Cancer Institute method, adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall analyzed (first/second) with outliers removed (final sample, n = 11,992). Usual intakes from food were assessed for prevalence of inadequacy in relation to DRI recommendations.ResultsCanadian macronutrient intakes were within the recommended acceptable macronutrient distribution ranges. EI was 2154 kcal/d for males (19+) and 1626 kcal/d for females (19+). A high prevalence of inadequate intakes was seen for vitamin A (>47%), vitamin D (>94%), vitamin C (>29% for nonsmokers and >59% for smokers), magnesium (>45%), and calcium (>44%), whereas <25% and <40% of adults (19+) had intakes above the adequate intake for fiber and potassium, respectively. Canadians continue to consume sodium in excess of recommendations (74.8% of males and 47.6% of females).ConclusionsA significant number of Canadian adults may not be meeting recommendations for several essential nutrients, contributing to nutrient inadequacies. These results highlight the nutrients of concern by specific age-sex groups that may be important for public health interventions aimed at improving diet quality and nutrient adequacy for Canadian adults.

Dataset Information

Defining 'actionable' high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology.

Publications

Defining 'actionable' high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets